The Vaccine Scene

The minimal pain of a temporary pin prick can help prevent a plethora of diseases that have plagued the human race for hundreds or even thousands of years. Timing the necessary shots correctly and being knowledgeable about vaccines is the first step in living a long, comfortable life. Pediatrician Dr. Darryl Robbins helps sort out the fact and fiction of vaccines.

How do vaccines work?

Vaccine injections create an immune response locally in the lymph nodes. The vaccine viruses or bacteria are modified to not cause human disease. They enter into an immune cell and creates a protecting antibody which then travels throughout the body to create a “global defense network.”

Can vaccines cause autism?

No. The widely publicized 1998 study published in British medical journal The Lancet was purposefully skewed with a developmentally delayed infant patient population, and this fact was subsequently uncovered by a journalist. Twelve subsequent studies have each refuted the claim.

Is there mercury in vaccines? If so, is it dangerous?

If you're an adult and reading this article, you can bet you have received thimerosal in vaccines multiple times. Thimerosal is ethylmercury and was used as a vaccine preservative. Due to public outcry that it could cause autism, it has been removed from all but one influenza vaccine. Six separate studies have refuted this claim. In contrast, methylmercury is the toxic form of mercury found in factory waste, some fish and many other places in the environment.

Why are booster shots necessary?

The enhanced immunologic memory of some or all of the protection of a vaccine may dissipate over time. Numerous population follow-up studies by infectious disease experts and medical epidemiologists demonstrate best known timing for specific vaccine boosters. For example, the measles, mumps, rubella (MMR) vaccine given at 12-15 months of age is ideally boostered at 4-6 years of age.

Why did the recommendations for the Tdap vaccine recently change for pregnant women?

In 1976, there were about 1,000 cases of pertussis (whooping cough) in the United States. In 2003 there were more than 11,500 cases of pertussis, and in 2012 we were up to 48,000. We have a problem. Ninety-one percent of deaths secondary to pertussis occur in infants less than six months of age, often due to brain bleeds from very intense and uncontrollable coughing. It is now recommended by the Center of Disease Control and the American Academy of Pediatrics to develop an immunologic cocoon around the newborn and young infant by protecting everyone who is in direct contact with the infant on a regular basis with pertussis vaccine. As a part of this recommendation, pregnant women should receive a pertussis vaccine booster between 27-36 weeks gestation with each pregnancy. This is a very safe approach for both the mother and the newborn.

Were the recent local mumps (Ohio State) and measles (Knox County) outbreaks linked to a lack of MMR vaccinations?

Not to any significant extent. Actually, there were several reasons for the outbreaks. First, vaccine refusal in certain populations was a culprit in the measles epidemic as it was introduced by international travelers returning to the United States. These travelers had measles or were incubating the virus at the time of their return. Secondly, a small number of people who received measles and mumps vaccines plus boosters may not have developed an adequate immunological response to one or the other of the vaccines, thus remaining susceptible to one of the two viruses.

For those entering college or any sort of communal living arrangement, what vaccinations should be considered and what are the most crucial?

Certainly the meningococcal vaccine is a must. It is now given routinely at 11 years of age and boostered at 16 years of age to prevent this infrequent but life-threatening infection. Then there is the human papillomavirus vaccine. This virus is the most common sexually transmitted disease, which we now believe causes about 70 percent of all cervical cancer in females as well as cancer in sexual contact sites in males. The goal for this vaccine is to prevent these very serious problems. Others, including the Tdap booster, need to be given or boostered per standardized vaccination schedules.

Can shingles be prevented by a vaccine?

Mostly yes. Shingles is the reactivation of the varicella (chicken pox) virus, which remains dormant in the body after the individual has had the infection. There are two ways in which immunizations may be helpful here. First, for preventing chicken pox. True, you can still get a mild form of herpes zoster (shingles) from the vaccine virus as well as mild breakthrough disease which can also occur. There is no foolproof escape here. Secondly, there is a herpes zoster vaccine for adults which is given to persons 60 years or older to prevent shingles, though again, it's not foolproof. This vaccine is licensed by the FDA for those 50 years of age and older.

What kinds of reactions to vaccines are normal and when should you contact your doctor over a reaction?

Common side effects include local reactions at the injection site as well as fever. Infrequently, a brief afebrile convulsion in an infant or toddler may follow the vaccine. These typically have no long-term consequences. In 38 years of practice, I have yet to see a serious reaction with any long-term consequences. They are very, very rare. I suggest calling your physician if there is a 104-105 degree temperature, persistent screaming for more than three to four hours in a row within a day or two of the injection and, of course, a febrile convulsion.

Are there any drawbacks to the recent trend of alternative vaccine scheduling?

The primary problem with the alternative schedule is that the duration for susceptibility for vaccine preventable diseases is prolonged. Secondly, alternative vaccine schedules have not been studied scientifically, so we don't know how effective they are. From a child's point of view, giving multiple shots at one point in time does not really increase pain. However, returning on multiple occasions to receive vaccines is much more painful, truly unnecessary and not very kind to children.

Any parting shots?

Throughout the 20th century, there were 160 million deaths as a result of wars. Also, throughout the 20th century, there were 300 million deaths due to vaccine-preventable diseases. That’s something to ponder. A terrific website to visit for more information is www.vaccine.chop.edu/parents.

Dr. Darryl Robbins

Darryl Robbins, D.O. is an American Board of Pediatrics-certified pediatrician with Pediatric and Adolescent Practitioners in Gahanna. He has worked as the president of the medical staff at Nationwide Children’s Hospital. He was also the president at Children’s Practicing Pediatricians and Medical Grand Rounds, coordinator and assistant clinical professor at The Ohio State University and has been a part of the Best Doctors in America by University Hospitals since 1996.

Robbins completed residency training at Cincinnati Children’s Hospital Medical Center and graduated from the Philadelphia College of Osteopathic Medicine. He also worked as a graduating pediatric resident at Nationwide where he received the Pediatrician of the Year honors in 1982 and 1990.